20130245 Ver 1_Application_20130312

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STATE OF NORTH CAROLINA v 0c Flay
DEPARTMENT OF TRANSPORTATYON rFRe� 'cy
PATRICK•L..WCRORY
GOVERNOR
January 16, 2013
N.C. Division of Water Quality
Transportation Permitting Unit
2321 Crabtree Blvd. /Suite 250
Raleigh, NC 27604 -2260
Attention: Mr. Rob Riding, NCDOT Project' Coordinator
ANTHONY J. TATA.
SECRETARY
20130245
Subject:' Proposed roadway construction and extension of a structure conveying
an unnamed tributary to the Tar River on SR 1148 (Russell Road) in
Granville County. WBS No. 5C.039049
The North Carolina Department of Transportation ( NCDOT) proposes to construct
SR 1148 (Russell Road) in Granville County.. This roadway improvement project will
.include grade, drain, base, pave, and erosion control for the project length of 0.6507
mile. This ,project will involve permanent stream impacts include surface water .fill, grip
.ap armoring for bank stabilization, and temporary stream impacts for de-watering. This
project is within the Tar - Pamlico River Basin and does' involve perman ent buffer
impacts. Application is hereby made for NCDENR -DWQ; Section 4"01 Watef Quality
Certification �(WQC) No. 3886. A pte- construction notification, historical clearance,
'construction pin sketch, project mapping, and photographs are attached with, this
request. By copy of.this letter we are notifying the USACE of the, intent to work -under a
non- reporting, NWP 14. If you have.any questions, or need-additional information, please
'contact Mrs. Heather Montague at (252)492 -0111 or hwmonta ue a ncdot.gov.
Sincerely,
dV4 h� �
J.W. Bowman, P.E.
Division Engineer
cc: Mr. Eric Alsmeyer, NCDOT Coordinator, U.S. Army Corps of Engineers
Mr. Cadmus Capehart, P.E.; District 2 Engineer
Mr. Jason Lee, NCDOT Granville County Maintenance Engineer
Mrs. Dawn Phipps, P.E. CPESC; NCDOT REU Field Operations Staff Engineer
Division Five — 2612 North Duke Street, Durham, North Carolina 27704
Telephone: [phone] Fax: 919 - 560.3371

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Date: 1-0/252012 Caption: SR 1148 Russell Rd
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Project Tracking No. (Internal Use)
12 -10 -0015
NO PREHISTORIC OR HISTORIC PROPERTIES
PRESENT /AFFECTED FORM
PROJECT INFORMATION,
Project No:
WBS.No:
F. A. No:
SR 11'48
5C.039049
na
Federal (USACE) .Permit Rewired?
Project Description:
County: Granville
Document: Minimum Criteria Sheet
Funding. State ❑ Federal
Z Yes ❑ 'No Permit 'Type: NWP# .14
The project calls for the improvement (grade, drain, base, and pave) of-the existing SR 1148 (Russell
Road) in Granvilk County. The archaeological Area or Potential Effects (APE) for the project is defined
as a 0.65 -mile (T,0_4607 in) ,long corridor starting.afthe junction of SR 1148 with SR 1138 (Culbreth
Road) in the west and running east to the end ofstate maintenance. The corridor includes the proposed
right -of -way and aneasures approximately 60 feet (18.29 m) wide extending 30. feet (9.14 m) on either side
front the.,new proposed center of SR 1148,
SUMMARY OF FINDINGS
The North Carolina D_ epartment of Transportation (NCDOT) `reviewed the subject project and determined:
Archaeology
® There are no National Register- listed or Study. Listed properties within,the project's' area of potential
effects.
❑ No subsurface archaeological investigations are required for this project.
'❑ Subsurface investigationsAid:not reveal the presence of any archaeological- resources.
® Subsurface investigations did not reveal the presence of any archaeological resources considered'eligible
for the National Register.
® All identified Archaeological sites located within the APE have been-considered and alb- compliance�for
archaeological resources with Section 106 of the National Historic Preservation Act and GS 12'1 -12(a) has
been completed for this project.
There' are no historic properties present or affected by this project. (Attach any'notes or documents as
needed)
"Nu Historic Properths Present "form for Minor Transportation Projects as Qualified in'the 1007 PrngranmialicAgreement.
NCDOT A rchaeolo} p & Hisroric- Archirecture Groups

12 -10 -0015
SUMMARY OF CULTURAL RESOURCES REVIEW
Brie f description of review activities, results of review, and conclusions:
'SR H 48 is north of the Tar River, south of Bcrca, and west of Oxford'in the western - central portion of
Granville County, North Carolina. The project area -is plotted-in the western half,of the Berea USGS 7.5'
:topographic: quadrangle, (Figure .1).
A map,review and site file search was conducted, at the Office of State Archaeology (OSA) on October 8,
2012. No previously recorded archaeological sites have been identified within or adjacent to the APE,
and no'sites have been reported within a mile radius. In addition, no existing National Register'of
Historic Places (NRHP), State Study Listed (SL), Locally Designated (LD), Determined Eligible (DE), or
Surveyed-Site (SS) properties- arc within the APE. However, the Latta family home.site (GV0403), a SS
property, is in-the vicinity of the APE (Figure 2). It is plotted by the State Historic Preservation Office
(SHPQ) at the western end ofthe road on its south side. Its location was confirmed during the
reconnaissance survey, and no associated archaeological features should be encountered during the
proposed road' improvements. Topographic maps„ USDA soil survey maps, aerialiphotographs (NC One
Map), and historic maps (North Carolina maps website) were,utilized to gage environmental factors that
may' have,contributed.to prehistoric or historic settlement within the project limits and to assess the level
bf grounddisturbance: An archaeological reconnaissance -and field survey was carried out on,October. 15,.
2012', 4o help assess the project.area.
From the west; the SR 1.148 °project area starts at its junction with SR 1138 and runs,east. The proposed'
-road improvements stop at the end of state maintenance. The road traverses two broad ridge tops that are
'separated by a,stream (see Figure 2). The waterway is situated in the western half ofthe project area.
This,stream.drains south and is an unnamed tributary to. the Tar River. Ivis also the location of the permit
site (Figures.3 and 4). The drainage consists of a very narrow stream terrace with gradual hillside slopes,
on either side. The project area is mostly wooded with a single cultivated:field to the,northwest: Overall,
modern disturbances-within -the APE appear minimal to moderate. A power 'line corridor crosses the road
at the permit location and then runs along the north side of the road to the east, whilea buried phone line'
is on' the.south side.
A review, of the.USDA soil isurvcy map�indicates that the APE consists of two soil'types (Figure 5). Most
'of the project area is, encompassed by Nason gravelly loam (NaB). This series occupies the eastern ridge.
It is well drained with a slope of 2 to 6 percent. The western ridge top and hillside along the drainage are
made "up of Georgeville silt loam (GeB, GeQ. This too is a well drained soil. Slopc along the ridge top
:is at Ito 6 percent, while the hillside,has a slope of 6 to 10 percent. Both of these series' have the
potential to yield significant and intact archaeological deposits due to been'well ,drained, fairly level, and
close to fresh water. For these reasons, subsurface testing was-recommended for the permit area.
Ari assessment of the site files showed that no archaeological- investigations have been carried -out in the
general vicinity resulting in no previously knownsites in the,area. Additional data is needed'beforeany
conclusions can be drawn on.the.predictability of archaeological,sites based upon previous investigations_
and'known sites.
A historic map review was also carried out. Most early maps from the 18th and f9th.century provide only
general features,of the region with few if anydetails of the project-area. No map from these periods could
be:found illustrating SR H 48 or a road with a similar alignment. It was not until the publication „of,the
I9'l0'soil 'map, f6r Granville County that a road �in the general vicinity, is shown (Figure 6). Whereas the
current road runs fairly straight, the road on, the soil' map is curved. The map plots two structures along
the, road with the westernmost likely being the Latta.family.house. The eastern structure appears to be
well.away from the current project area and should not be a concern. Subsequent maps ,from:the early
20th- century, which'are not copies of the soil map, fail to show the road since it is _likely not maintained
"No Hismrie Properties Piesenl ” forni fitr Minor Transportarion'Prgjects as Quedired in the 2007 Programmatic Agreement.
NCDOT Arc /roevhW, & Hisviric Architecture Groups
2-

14-16-00115
by the,state. However, the road location can still be determine since maps such as the 1938-North
Carolina State Highway map-.of the-Granville County continue -to show the western structure (Fi'gure'7).
As a',result'of this review, it is very unlikely deposits associated with former historic structures will be
encountered within the APE.
The' archaeological investigations at SR 1148 consisted of shovel test placements (STPs). In all, 23 STPs
were excavated (see Figures 2 and 5). Shovel tests were initially placed at, 30 -m intervals on either- side of
the drainages within the - permit area. Ten STPs were excavated west of the stream'with five'on either side
of the road, and another eight to the east with four on either side. STP# 17 yielded a prehistoric artifact,
which resulted in the excavation of five additional STPs at 15 -m intervals- around the positive (Figure'8).
Soil stratigraphy consisted of two',strata throughout the - tested area. Soils along the hillside and floodplain
have an upper layer of strong brown (7.5YR 4/6) loamy clay or dark grayish brown (1 OYR 412) loam that
is'5 to 25 cm (2 'to 10 in) thick. If is followed by subsoil, which is a red (2.5YR 5/8) clay. Soils on the
western ridge,top consists "ora 20 cm (8 in) thick upper layer•of dark yellowish brown,(lOYR 3/4) loam..
It is followed by'yellowish red (5YR 4/6) clay subsoil. Lastly, soils on the eastern ridge top', which
includes the positive STP, have an upper layer of brown (10YR 4/3) silt loam That is. approximately 115 to
25 �cm (6 to 10 in) thick. Bericath'this is' a layer of light yellowish brown (16YR 6/4) silty clay subsoil'.
Attempts a surface inspection fail due to poor visibility. One prehistoric, site (31 GV319) was' identified
within the APE.
Site 31.GV319 is an isolated artifact- occurrence dating to an unidentified prehistoric period. It is located
east ofthc drainage along a ridge top composed of Nason.gravelly loam-within the power line corridor
(Figure, 9;, gee Figure'.8). 'The - artifact, a single meta - volcanic flake, was recovered within the upper
stratum (Table 1). Additional STPs excavated to the north, cast, and west:produccd no other material.
The "site area is disturbed from -not only the utility corridor but also from access road to the east of
ST.P# 17. The site is recommended.as,incligible for NRHP, since it is -an isolated artifact occurrence with
very little research potential. No further work is required at this site.
The-location.of the Latta - family home site,was"also confirmed at SHPO reported location-approximately
60 m (197 ft) south of the road (see Figures 2 and 5). The home site consists of two standing log houses,
a fallen, timber, frame house, a timber framed barn, a log shed or corn crib, a'fallen shed, and a rock line
well- (Figures 10 -14). The, log structures appear to use either a saddle or V -notch construction method
and mighchave been relocated from elsewhere. All of the structures appear to have been refurbished-at
some point during the 20th, century, with modern brick for the chimneys and foundations and cement
placed in the�chinks for weatherproofing. It also.appears that the metal roofs are not original. As some
point during the, last 20 to 30 years care of the structures was abandon, and the structures subsequently
became dilapidated. All.of the structures-, are situated well outside of the APE, -and no possible =associated
features will be impacted by the proposed road improvements.
The archaeological'investigations for-the proposed improvements'to SR 1 148 suggest no significant
archaeological, sites within the APE. Although investigations identified one new prehistoric site within
the project limits, the site consists of,a single,artifact with no intact cultural ",deposits. As a result, site
31GV31 -9 is.determined ineligible for the NRHP. Also-, the scope'of the project willonly:impact - a
minimal area of properties on either side of "the road, and the historic trap review identified
ed
no former structures or significant features within the project limits. Thin includes 'the Latta family home
site, whose location was confirmed as outside of the project limits. As long as impacts to the subsurface
occur within the defined APE, no further archaeological work is required forrroad improvements to -SR
1'148.in Granville County. 'Should the design, funding, or permit requirements change, .further
arc haeological consultation will be necessary.
"No Hlurir`ic Properties Present "fi)rni fi r Minur Tiansportation Projects as Qualified in the,21107, Programmatic Agreemuu.
NCDOT Archaeology & Historic Archilecture Groups
I

12 -10 -0015
SUtPORT DOCUMENTATION
Seezttached; Map(s), Previous Survey Info, Photos, Correspondence, Photocopy of notes from survey.
Signed:,
C. Damon Jones
Cultural Resources Specialist, NCDOT
10/48/12
Date

(HA')1240 -0015
NO SURVEY REQUIRED .FORM
PROJECT INFORMATION
Project No: County: Granville
WBS No 5C.039049 Document:
FA. No: Funding: X State, Federal
Federal. (USACE) Permit Required? X Yes No Permit Type: NWP 14
Project Description: Grade, drain, base, add erosion control; and pave SR 1148 (Russell
Road), eastfrom'SR 1138 (Culbreth Road) to dead end (no off- site - detour planned).
SUMMARY-OF CULTURAL.RESOURCES REVIEW
Brief description of review activities, results of review, and conclusions: HPOWeb reviewed on 5 October
2012 and yielded 'one SSi and 'no NR, SL, DE, ,or LD properties, in the Area of Potential Effects (APE).
Granville County" current GIS mapping, aerial photography, and tax'information indicated a predominantly'
wooded APE (viewed 8 October 2012). Properties intersected by the APE near-the western and eastern
ends'of,the. project, contain pre -1960 resources, including the Latta Family House (GV 403 - SS), all
located well beyond likely project impact. There are no National Register- listed or - eligible properties in
the Federal'permit area'and no NR- listed properties in the APE of the state- funded project.
No architectural survey is required for-the project as currently defined.
Brief Explanation of why the available information provides a reliable.basis for reasonably predicting
that theretare ono unidentified historic properties in ,the APE: APE extends 100 feet to either end of the
proposed 0 .6507 7mile: project'length,(E -W) and 100 feet to either side ofthe SR 114 (Russell Road)
centerline (S -N) to encompass proposed construction activities. The - project is °state- funded, so GS 12-
12(a) applies, and the Federal permit area is also subject to; Section 106.
Should, the design, funding, or permit requirements of the project change, please notify
NCDOT Historic Architecture as additional, review may be necessary.
SUPPORT DOCUMENTATION
See attached: location map
FINDING BY NCROT-CULTURAL RESOURCES PROFESSIONAL
NO SURVEY REQUIRED — Historic Structures,
.0)
Cultural- Resources Specialist Date
"No Sun ep Regrared "form for Muior• 7Yr ucporraian Paijecrs as Qual jet in the ?007 Progrannoaric Agrecuiew.
NC.'DOT Archarologp X Hisioric ArchAeume Groups

o�oF wArfi9QG
o -c
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec'10 2008
Pre-Construction Notification CN) Form
A. Applicant Information
1, Processing
1a: Type(s) of approval sought,from the
Corps:, non - reporting
®,Section 404 Permit. El Section 10 Permit
1b: Specify Nationwide Permit (NWP) number: non - reporting NWP 14 or General Permit (GP)',number'
1c. Has the:NWP or GP number been verified by,the Corps?
❑ Yes
® No
Iii. Type(s) of approval sought from the DWQ (check all that:apply):
® 401 Water Quality Certification- - ,Regular ❑ Non- 404,Jurisdiciional General Permit
401• Water Quality Certification - Express ® Riparian Buffer Authorization
le. Is.this notification solely for the record
because written approval-is not required?
For the record only for DWQ 401.
Certification:
❑ Yes ® No
For the record only for Corps Permit:
® Yes ❑ No.
'1f: Is,payment into a mitigation bank or,in -lieu fee program proposed for mitigation
ofimpacts? If so, attach the acceptance letter from mitigation bank or'in -lieu,
fee'program.,
Q'Yes
® No
1.g. Is,,the'project located in any of NC's twenty coastal counties. If yes, answer 1 h'
below.
Yes
N No
1h. Is-the project located within a NC DCM Area of Environmental Concern (AEC)?
Q Yes
® No
2. Project Information
2a. 'Name of,project:
Proposed upgrading and paving SR 1148 (Russell Road)
2b.-County:
Granville
2c. Nearest municipality,/ town:
Berea
2d. Subdivision name:
N/A
2e. NCDOT'only, T.,I.P. or state
project, no:
WBS'No. 5C.039049
-
3. Owner'Information
3a. Name(s) on Recorded Deed:
NCDOT Division 5
3b. 'Deed'Book and Page No.
'N/A
3c. Responsible. Party ,(for LLC.if
applicable):
N/A
3d. Streetaddress:
2612 N. Duke Street
3e. 'City, state, zip:
Durham, NC 27704
3f. Telephone no::
(91,9)220 -4600
3g, 'Fax no.:
(919)560 -3371
3h. Email.address:
[e-mail]
4. Applicant Information,(if different from owner) NIA
5. Ageht/Cortsultant Information (if applicable) N/A
Page 1 of 8
PGN' Form - Version 1.$ December 10;,2068 Version

B. Project Information,and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
N/A
1 b, Coordinates (in decimal degrees):
Site:
Latitude: 36.30357 Longitude: - 78.72966
(DD.DDDDOD) (= DD.DDDDDD)
1c. Property.size:
4.7 acre (0.6507mi long project with 60ft ROW)
2: Surface Waters
-2a. Name of nearest body.of water (stream,. river, etc:) to
UT to Tar River
proposed project:
2bi Water Quality Classification of nearest receiving water:
WS =IV NSW
-2c. River'basin:
Tar - Pamlico
3. Project Description
"3a. Describe the existing-conditions on the site and the general land use in the vicinity of the project -at the.time,of this
application:
'The existing pipe' needs to be extended to support road improvements: Site is,surrounded by wooded land agriculturat
land.
3b. List the•total estimated acreage of all existing wetlands oh the property:
NONE
3c. List the total estimated linear feet`of all existing streams (ihtermittent.and perennial) on the property:
90ft
3d. Explain:the purpose of the, proposed. project: The pipe,extension.will facilitate road improvements through this crossing.
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing 28ft long, concrete pipe will be extended 16ft to either end (4 'joints). Rip rap will be'installed underlined with
geotextile for- long term stability surrounding Ithe mouth of the new pipe ends. The NCDOT will also dewater the work
zone as needed'durin .construction., Equipment ma include an ezcavator,_a backhoe _a.b'ulldozer _and: grader.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
❑Yes ®No ❑Unknown
project (including, all prior, phases) in the-past?
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
❑ Preliminary ❑ Final
&- determination was made?
4c.. If yes, whoAelineated the jurisdictional areas?
Agency /Consultant'Company: N/A
Name (if known):'N /A
Other.: N/A
4d: If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5: Project History
5a. Have permits or,certifications been requested or obtained for
❑Yes 0,M ❑ Unknown
this!project- (including all prior phases) in the past?
5b. If'yes, explain in detail according,to "help file" instructions:
N/A
Page 2 of 8
PCN. Form, — Version 1.3,December 10; 2008 Version'

6. 'Future Project Plans
6a. Is this a' phased project?
❑ Yes ® No
6b. If yes, explain.
N/A
C.. ,Proposed Impacts Inventory
1. Impacts Summary,
1a:. Which.sections were completed below for your project (check all that apply):
i-
,
❑;Wetlands, ®'Streams•- tributaries ® Buffers
❑;OpenWaters ❑,Pond Construction
2. Wetland Impacts•
if there are wetland impacts, proposed on the site, then complete this question for -each wetland area impacted.
-2a.
2b.
2c.
2d.
2e.
2f:
Wetlandjinp'act
Type: of.jurisdiction
number —
Type,of'impact
Type of wetland
Forested
(Corps - 404, 10
Area of,impact
'Permanent' (P) or
(if known)
DWQ — non -404, other)
(acres)
-temporary
W1 ❑ P ❑ T
'N /A
N/A
El Yes
❑ No
❑ Corps
❑ DWQ
N/A
2g. Totait Wetland Impacts:
NONE
2h. Comments: N/A
3. 'Stream Impacts
If' there;are,perennial or intermittent.stream,impacts (including. temporary impacts) proposed on the site; then complete this
question for, all stream sites impacted.
3a.
3b:
3c.
3d.
3e.
3f.
3g•
Stream-impact.
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent'(P) or
intermittent
DWQ - -non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
Site 1 '® P ❑ T­
pipe fill
UT to
® PER'
® Corps
2
32
Stream 1
Tar River
_❑ INT
® DWQ_
Site 1 '® P❑ T
UT to
® PER
.®'Corps ~
2
25
Stream 1
rip rap
Tar River
❑1NT
® DWQ. _
Site 1 ❑'P ® T
dewaterin g
UT to
® PER
® Corps
2
25
Stream 1
Tar River
❑ INT
® DWQ
concurrent
3h. Total'stream and tributary impacts
57
1. Comments: Rip rap will, be placed on banks only for stabilization. Due to the curve in'the stream,, note that'a slight channel
change will be- necessary on the;outlet to'redirectflow from the new. pipe end.
4. Open Water Impacts
If there are proposed' impacts to lakes, ponds,. estuaries, tributaries, sounds, the Atlantic Ocean, or,any other open water of
the,U.S. then individually list all open water impacts below.
4a:
4b:
4c. _
4d.
4e:
i
Open,water
Name-of
impact number-
waterbody
Type of impact
Waterbody type
Area of impact (acres)
Permanent.(P) or
(if applicable)
Tem ora '
01 ❑ P ❑ T
N/A
N/A
N/A
N /A,
4f. Total open water impacts
NONE
4g. Comments: k/A _
Page 3 of 8
PCN Form --Version 1.3 December 10, 2008 Version

S. Pond,or Lake Construction
If pbndor,lake construction proposed, the complete the chart below.
'5. a,.
5b.
'5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose -of
(acres)
number'
pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P11
N/A
N/A
N/A
N/A
N/A
N/A
NA
N/A
,P2
5f. Total
NONE
NONE
NONE
NONE
NONE
NONE
'NONE
5g., Comments: NIA
5h::ls Adam high hazard permit required?
-
El Yes ®No If yes, permit ID no: N/A
Si: Expected pond surface area (acres);
N/A
5j. Size =of pond - watershed (acres):
N/A
5k. Method of construction:
N/A
6:.,13uffer Impacts;(for DWQ)
14(dject will impact.a protected riparian,buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts, require mitigation, then you MUST fill out,Section:D of this form.
6a.
❑ Neuse ,® Tar: Pamlico r! Other:
Project'is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number—
Reason'for
Buffer
Zone 1 impact
Zone 2 impact
Permanent' (P) or
impact
Stream name
mitigation
(square feet)
(square feet)
Tem ora
required?
Site ®.P El T
Pipe extension
El Yes
Buffer Impact 1
for road
UT to Tar River
® No
2,700
2,050
improvements
m
6h. Total buffer impacts
2,700
2,050
6i'.: "Gornments:'Necessary improvements of"expanding.this roadway from 46ft- maintenance limits to 60ft ROW will involve
impacts to, buffers.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
Ia. Specifically describe, measures,taken.to avoid or minimize the.proposed. impacts in- Aesigning project.
Rip rap armoring around the pipe ends and,tie -in points to the existing stream back will be; limited only to the amount
necessary to ensure, long term- stability.
1 b; Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sediment and erosion control Best Management Practices for protection of surface waters will.be enforced during project
E construction.
Page 4 of 8
PCN Form — Version 1.3 December 10; 2008 Version'

2. Compensatory, Mitigation for Impacts to Waters of the U.S. or Waters of the -State
2a-.,'D'oes the, project: require Compensatory Mitigation for
impacts tb- Waters of the U.S. or Waters.of the.State?
❑ Yes ®-No
2b. If yes, mitigation, is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which'mitigation option will'be used for this project?
❑ Mitigation,bank
❑ Payment.to in -lieu fee program
❑ Permittee, Responsible Mitigation
I. Complete If Using a Mitigation Bank
3a. Name of Mitigation Bank:- N/A
'3b.'Credits'Purchased'(attach receipt and letter)
Type N/A
Quantity N/A
3c. Comments: N/A
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee.program is attached.
❑ Yes
4b. Stream' mitigation requested:'
N/A linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑cool ❑cold
4d. Buffer mitigation requested (DWQ only):
N/A square feet
4e. Riparian wetland mitigation requested:
N/A acres
4f. Non= riparian wetland mitigation requested:
N/A acres
4g. Coastal (tidal) wetland mitigation requested:
N/A acres
4h. Comments: N/A
5. 'Complete'if Using,a 'Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
N/A
6. Buffer Mitigation. (State, Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result,in animpact, within. a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the ;square -feet of impact to each.zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for'impact
6d.
Total impact
(square feet)
Multiplier
6e:
Required mitigation
(square feet)
Zone 1
N/A
N/A
3 (2 for Catawba)
N/A
-Zone 2
N/A
N/A
1.5
N/A
6f. Total buffer mitigation required:
NONE
�6g. If buffer mitigation is required; discuss what type of mitigation is proposed (e.g., paymentto private mitigation, bank,
permittee: responsible- riparian buffer restoration, payment into:an approved in -lieu fee-fund). N/A
ZK Comments: N1A.
Page 5 of 8
PCN Form — Version 1.3 December 10, 2008' Version

E StorrnWater Management and' Diffuse Flow Plan (required by DWQ)
'1. Diffuse Flow'Plan
1a. Does the',projectinclude,ori §,it adjacent,to,protected riparian;buffervidentified
Yes ❑. Na
within one,of'the NC Riparian Buffer Protection' Rules ?'
1b. If yes, then•is a diffuse flow plan included? If no, explain why.
Cbmments:'this:pipe replacement will not, alter storm water runoff at this site, no 'new
❑Yes ®No
diiches�will be cut through - the:buffers
2. Stormwater _Management Plan
2a: What is the overall percent imperviousness of this project?
<20 %
2b,. Does this,projebt require , Stormwater Management Plan?
❑Yes ®:No
2c. If this•project DOES -NOT require a- Stormwater Management Plan, explain why: no new ditches will-be cut,through buffers
2d. If this.project DOES-require a Stormwater Management:.Plan, then provide a brief, narrative description of the,plan: N/A
El Certified Local Government
2e: Who will be responsible for the review of the Stormwater.Management Plan?
❑ DWQ Stormwater Program
❑ DWQA01 Unit
•3. Cert'i'fied Local Government Stormwater Review
3a. In whichAbcal governments-.jurisdiction is,this project?
N/X
❑ Phase II
❑ NSW
3b. Which of the following locally-, implemented stormwater management programs
❑:USMP
apply (check-all that apply):
Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater,Management Plan,witli proof of approvalibeen
[]'Yes No
attached? N/A
4. DWQ Stormwater. Program Review
Coastal counties
❑ HQW
46. Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply): N/A-
❑ Session, Law 2006 246
❑ Other:,
4b. Has,the approved Stormwater Management Plan with proof of approval been
'
Yes .No
attached? N/A
5. DWQ 401 Unit Stormwater Review
5a. Does the' Stormwater Management Plan meet the appropriate requirements? N/A
[]Yes ❑ No
5b.,HaveAll;oftheAM Unit submittal requirements been met? N/A
❑ Yes ❑ No
Page 6 of 8
PCN Form — Version 1.3 December 10, 2008 Version

F: Supplementary Information
1. 'Enviironmental.,Documentation (DWQ Requirement)
1a, Does the project involve ameixpenditure of public (federal /state /local) funds or the
®Yes ❑ IVo
use of public (federal /state) land?
1b. IUyou,answered' "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Y,es, ® No
(North,Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. ,if,you-answered' "yes" to the.above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑Yes ❑'No
letter,.)'
Comments: N/A
2. Violations (DWQ Requirement)
2a. Is the, site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Welland 'Rules _(15A NCAC 2H..1300), DWQ Surface Water or Wetland- Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B ;0200)?
2b. Is this an after- the -fact permit application?
❑ Yes, ® No
'2c, If you.answered' "yes" to,one or both of'the above questions, provide an explanation of the violation(s): N/A
3: Cumulative Impacts (DWQ Requirement)
3a. Will this. project .(based. on past'�and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which.could impact nearby downstream water quality?
3b. If you answered "yes" toAhe above, submit a-qualitative or quantitative, cumulative impact.analysis'in accordance wiffthe
most,recent DWQ.,policy. If,you answered'no," provide a, short narrative description.
N/A
4: Sewage Disposal (DWQ Requirement)
4a. Clearly detail,the ultimate.treatment methods and disposition (non- discharge or discharge) of wastewater generatedfrom
the,proposed project, or available capacity-of-the subject facility.
N/A
Page 7 -of 8
PCN' Form —Version 1.3 December 10, 2008'Version

5. Endangered Species and Designated Critical Habitat (Corps�Requirement)
5a. Will, this, project'occur in'or near an area with federal ly'protected.species or
F]' Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered. Species Act
0-Yes ® No
impacts?
❑ Raleigh
5c. If yes, indicate.the USFWS Field Office you have contacted.
❑ Asheville
.,5d: What data sources;did you use*to,determine whether your site would impact Endangered Species or Designated "Critical
Habitatl
http:// www :fws.gov /nc- es /es /count)dr.html and NC Natural Heritage Program Database, Element Occurrences
6. Essential Fish Habitat (Corps Requirement)
6a. Will-this-,project occur in or near,an area, designated as esseritial fish
El Yes ®,'No
t
habitat'?
6b. What .data. sources .did,you use to determine whether your site would impact Essential'Fish.Habitat?
http : / /ocean.floridamarine:org /efh coral /ims /viewer:htm
7. Historic or Prehlstoric�Cultural Resources (Corps Requirement)
7a. WilL this projecf:occur in or near an area that -the state, federal or tribal
'governments have designated as; having, historic or cultural :preservation
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
'North Carolina history,and archaeology)?
7b: What data sources did you use to,determine,whether your site would impact historic or archeological resources?
HPO's historic layer using GIS ArcView database, SHFO's webpage http://gis.ncdcr.go"v /hpoweb /, and FDEA HEU review
1. Flood Zone Designation (Corps Requirement)
8a: Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements: N/A
8c.. What,source(s) did, you use to make the fioodplain determination? http: / /www.ncfloodmaps.com/
for J. W. Bowman, P.E.
01/16/13
Applicant/Agent's Printed Name
Date
Applicant/Agent's 'Signatur
(Agent's signature is valid only 11 "an.authorization' let horn the applicant
Is provided.)
Page 8 of 8
PCN Form — Version'l .3 December 10, 2008 Version.

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